Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

The absurd barriers to good patient care

Peter Elias, MD
Physician
June 21, 2015
383 Shares
Share
Tweet
Share

shutterstock_267055247

Our job — though many of us actually see it more as a calling than a job — is to care for patients.

Documentation is a process whose primary purpose is to support the patient care process. Coding, billing, population management, meaningful use and many other processes may be important to an institution but are of little or no use (and provide little or no benefit) to the individual patient. These things will not go away. Nor should they, as they serve legitimate purposes.  But they should be done in a way that they do not interfere with, or distract from, the primary purpose of a health care institution: caring for patients.

The typical medical institution has long since lost its way. The machinery for coding and billing is just one small manifestation of this.

I liken what has happened to most health care organizations to the difference between a local baker and a national business that makes and distributes bread products.  The baker is intimately familiar with her ingredients, the bread making process, the product, and the needs of her customers. She will also need to be aware of the cost of her ingredients, the price of her bread compared to others on the market, and other commercial issues involved in selling her bread, but on a day-to-day basis, making bread that smells and tastes good, and serves the needs of her customers, is the thing that is most important and most real to her.

Now imagine that her business thrives, the volume of bread she sells grows, and it becomes a big national industry.  To maintain a big and complex industry requires individual people working at individual pieces of bread making: some put flour into big vats, others purchase yeast, still others drive trucks and deliver product to stores. They may all be very focused on the performance of their individual roles, but they have no connection to the bread in the customer’s kitchen. Efforts by individuals in this complex system to maximize the quality and efficiency of their piece may, in fact, be detrimental to the efficiency of the process as a whole, and may even degrade the quality of the bread. Worse, the people who own and run the organization and make all the decisions have quite probably never baked bread. Their expertise is in areas like business, finance, risk management or human resources. Their awareness and goals are entirely focused on maintaining the business and its processes. They simply assume that the bread exists and meets adequate standards – as defined by the business.  The bigger the industry, the greater the chasm between the decision makers and the actual product.

This is what has happened in medicine. Institutional policy and operational decisions are made by people who have no experience in or expertise with actual patient care. People like me are expected to be little MacGyvers using and repurposing broken clinical and non-clinical tools in an attempt to provide quality care in an environment that too often sees medical care as an almost accidental byproduct rather than as the prime purpose.

This is a cultural and systems problem. The individual department heads, managers, and mid-level leadership don’t own this, and my frustration is not directed at them. The process of health care should be to 1) make sure patients get quality care using systems are set up explicitly to support this; and, 2) do this in a way that also captures appropriate documentation and reporting for billing and audit.

Instead, most organizations evolve huge complex and inflexible machinery that is so focused on the billing and audit process that it impedes care, and actual interest in care or quality is appallingly absent in the planning and management process.

Here is a simple and real-world example from my institution: Recently the social history and risk factor forms in the EHR were changed in order to capture MU data better, with no regard for the fact that the changes hid important clinical information and made the clinical work flow harder. This happened with no warning or training; clinicians came in, and the forms had been changed the night before. There was no clinical input in the process. Contrast this with the coming ICD-10 roll out, where there are two mandatory live training sessions and two online training modules (total commitment of 6 hours) in order to make sure billing goes smoothly.

The priorities of health care institutions are broken.  When we clinicians work really hard and do a bang-up job with complex patients despite systems that make it very difficult to do so, it really rubs us the wrong way when we cannot get traction or resources for our concerns about the actual patient care process.

If health care institutions ever start spending time and energy helping us improve our ability to provide good care, then we might be more willing to join your committees, go to your meetings, read your memos, and spend more time and energy on billing and administrative processes. At the moment, to paraphrase a famous movie, we frankly don’t give a damn. It isn’t worth it to us, and we’re too tired after struggling all day with unnecessary friction and absurd barriers to good patient care.

As I said, our job is to care for patients. Your job is to ensure we have the tools and support to do our job.  We are doing our job. It’s time for you to step up to the plate and do yours.

Peter Elias is a family physician who blogs at his self-titled site, PeterEliasMD.

Image credit: Shutterstock.com

Prev

Questioning the commitment today's physicians have to medicine

June 21, 2015 Kevin 14
…
Next

Learn to be a primary care mentor. Our future depends on it.

June 21, 2015 Kevin 9
…

Tagged as: Primary Care

Post navigation

< Previous Post
Questioning the commitment today's physicians have to medicine
Next Post >
Learn to be a primary care mentor. Our future depends on it.

More by Peter Elias, MD

  • A doctor’s coronavirus straight talk

    Peter Elias, MD
  • It shouldn’t be so hard for patients to correct their medical record

    Peter Elias, MD
  • 10 rules every primary care doctor should read

    Peter Elias, MD

More in Physician

  • Decoding name displays in health care: Privacy, identification, and compliance unveiled

    Deepak Gupta, MD
  • Master time management with 7 productivity strategies for optimal results

    Farzana Hoque, MD
  • The tragic story of Mr. G: a painful journey towards understanding suicide

    William Lynes, MD
  • The escalating violence in health care workplaces: a critical problem facing the nation’s health care system

    Harry Severance, MD
  • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

    Howard Smith, MD
  • Why allowing yourself to embrace discomfort is necessary for personal growth

    Jillian Rigert, MD, DMD
  • Most Popular

  • Past Week

    • The power of coaching for physicians: transforming thoughts, changing lives

      Kim Downey, PT | Conditions
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • Physician entrepreneurs offer hope for burned out doctors

      Cindy Rubin, MD | Physician
    • We need a new Hippocratic Oath that puts patient autonomy first

      Jeffrey A. Singer, MD | Physician
    • Boxing legends Tyson and Foreman: powerful lessons for a resilient and evolving health care future

      Harvey Castro, MD, MBA | Physician
    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
  • Past 6 Months

    • Breaking point: the 5 reasons American doctors are dreaming of walking away from medicine

      Amol Shrikhande, MD | Physician
    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
  • Recent Posts

    • Decoding name displays in health care: Privacy, identification, and compliance unveiled

      Deepak Gupta, MD | Physician
    • Empowering Black nurses for lasting change [PODCAST]

      The Podcast by KevinMD | Podcast
    • Master time management with 7 productivity strategies for optimal results

      Farzana Hoque, MD | Physician
    • Proposed USPSTF guideline update: Advocating for earlier breast cancer screening at age 40

      Hoag Memorial Hospital Presbyterian | Conditions
    • The rising threat of lung cancer in Asian American female nonsmokers

      Alice S. Y. Lee, MD | Conditions
    • The tragic story of Mr. G: a painful journey towards understanding suicide

      William Lynes, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 3 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Novel Anti-HER2 Drugs 'Impressive' in Advanced Biliary Cancer
  • What Was Tied to Lower Long COVID Risk?
  • Chemo-Free Approach Works in Subset of Patients With HER2+ Early Breast Cancer
  • Two-Drug Combo Wins for Refractory Gout
  • First-in-Class Sjogren's Drug Passes Mid-Stage Test

Meeting Coverage

  • Novel Anti-HER2 Drugs 'Impressive' in Advanced Biliary Cancer
  • Chemo-Free Approach Works in Subset of Patients With HER2+ Early Breast Cancer
  • Two-Drug Combo Wins for Refractory Gout
  • First-in-Class Sjogren's Drug Passes Mid-Stage Test
  • Pricey Drug Combo Boosts PFS in First-Line Advanced Ovarian Cancer
  • Most Popular

  • Past Week

    • The power of coaching for physicians: transforming thoughts, changing lives

      Kim Downey, PT | Conditions
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • Physician entrepreneurs offer hope for burned out doctors

      Cindy Rubin, MD | Physician
    • We need a new Hippocratic Oath that puts patient autonomy first

      Jeffrey A. Singer, MD | Physician
    • Boxing legends Tyson and Foreman: powerful lessons for a resilient and evolving health care future

      Harvey Castro, MD, MBA | Physician
    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
  • Past 6 Months

    • Breaking point: the 5 reasons American doctors are dreaming of walking away from medicine

      Amol Shrikhande, MD | Physician
    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
  • Recent Posts

    • Decoding name displays in health care: Privacy, identification, and compliance unveiled

      Deepak Gupta, MD | Physician
    • Empowering Black nurses for lasting change [PODCAST]

      The Podcast by KevinMD | Podcast
    • Master time management with 7 productivity strategies for optimal results

      Farzana Hoque, MD | Physician
    • Proposed USPSTF guideline update: Advocating for earlier breast cancer screening at age 40

      Hoag Memorial Hospital Presbyterian | Conditions
    • The rising threat of lung cancer in Asian American female nonsmokers

      Alice S. Y. Lee, MD | Conditions
    • The tragic story of Mr. G: a painful journey towards understanding suicide

      William Lynes, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

The absurd barriers to good patient care
3 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...